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The "U" Curve

Depression peaks worldwide for the middle-aged.

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Middle age is truly miserable, according to a study using data from 80 countries showing that depression is most common among men and women in their 40s.

British and U.S. researchers found that happiness for people in countries ranging from Albania to Zimbabwe follows a U-shaped curve, where life begins cheerful before turning tough during middle age and then returning to the joys of youth in the golden years.

Previous studies have shown that psychological well-being remained flat throughout life, but the new findings to be published in the journal Social Science & Medicine suggest we are in for a topsy-turvy emotional ride.

"In a remarkably regular way throughout the world, people slide down a U-shaped level of happiness and mental health throughout their lives," Andrew Oswald of Britain's Warwick University, who co-led the study, said.

The researchers analyzed data on depression, anxiety levels, and general mental health and well-being taken from some 2 million people in 80 countries.

For men and women, the probability of depression slowly builds and then peaks when they are in their 40s — a similar pattern found in 72 countries, the researchers said.

About eight nations — mostly in the developing world — did not follow the U-shaped pattern for happiness levels, Oswald and his colleague, David Blanchflower of Dartmouth College, wrote. "It happens to men and women, to single and married people, to rich and poor, and to those with and without children," Oswald said. "Nobody knows why we see this consistency."

One possibility may be that people realize they won't achieve many of their aspirations at middle age, the researchers said. Another reason could be that after seeing their fellow middle-aged peers die, people begin to value their own remaining years and embrace life once more.

But the good news is that if people make it to 70 and are still physically fit, they are on average as happy and mentally healthy as a 20-year old.

"For the average person in the modern world, the dip in mental health and happiness comes on slowly, not suddenly in a single year," Oswald said. "Only in their 50s do people emerge from this low period."

The occurrence of depressive illness is rising. Currently, depression is ranked fourth among the 10 leading causes of the global burden of disease. The World Health Organization estimates that by 2020, it will have moved to second place. On average, twice as many women as men suffer from depression. Between 10 and 20 million people attempt suicide each year. More than 800,000 succeed.

For centuries, there were few ways to treat mental and brain disorders.

During the 19th century, humanistic reforms led only to the building of nicer asylums to hide the mentally ill from the rest of us. Public fear of insanity undermined efforts to reform mental-health policies. In 1959, the World Health Organization reported that "great numbers of mentally ill people are still shut away behind walls by the prejudices and incomprehension of society. The efforts to have the mentally ill treated as other sick people who can be cured are likely to remain fruitless as long as irrational fear of 'madness' is not conquered.''

A recent World Health Organization survey covering 185 of 192 member states showed that the situation has not changed much in the last 40 years. In 43 percent of the countries studied, there was no policy for addressing mental-health issues.

Fortunately, medical facilities both public and private are reaching out to formulate proactive programs. Further improvements are likely thanks to rapid advances in understanding how the brain works. Currently, there are cost-effective interventions which enable most persons with mental, brain, or behavioral disorders to become functioning and productive members of their communities and to live normal lives.

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